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16559 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER " CITY OF CUPERTINO 16559 INSPECTION DIVISION JOB INSPECTION RECORD. PERMIT EXPIRATION JOB ADDRESS SCK q ji,4812--1 TIG UNIT# _LOT# , 1 PERMIT EXPIRES IF WORK OWNER j Iv CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATIONANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF _ 'LRMfT VALIDATION CUPERTINO STANDARDS. GARAGESLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _ UNDERGROUND /SLAB PLUMBING. '� +�•!� i' ELECTRICAL ISSUANCE DATE BLDG ELECT PLG. MEC. MECHANICAL � r ❑ ❑ •�' ❑ DO NOT POUR FLOOR UNTIL-ABGVE HAS BEEN SIGNED BUILDIN PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL sv PERMIT TO ELECTRICAL QQQ ` FRAMING .- C ,' �9V " L Jpe<i"`Bvua T Pe coNSTR INSULATION :hl Q1 OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT EI.00R AH CA T7AT,ALHEAGf ROOF I NOTE:NO FINAL INSP.SHALL BE MADE BEFORE ow DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE, ROOF SHEATHING .Es IND cON PB DO— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El ❑ ❑ ❑ ❑ ASSESSCRS PARCEL NO ROUGH SAN.a PLUMBING ELECT.ENERGY TRACT NO YAHCLL NO TUBS&SHOWER PAN . PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC DATE ACC FILE NO ELECTRICAL - BUILDING ENERGY FRAMING ELECT,FINAL TEST ZONING ENG SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE SPRINK ENERGY T-]< MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y E] O N[—] ❑I N . ❑. FLOOD zuNE A,L u:c. EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR ' - FIRE DEPT. v� N� YLJ NEI SHEETROCK GRADE FEESUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING G 00 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE MECHANICAL — IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE 'TOTAL lqoo CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY • BZS ROJECT I DENTI FICATION 'PERMIT NUMBER BUILDING APPLICATION & PERMIT 16559 ADORE - BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER 'J �y/^`/� PLAN CHECK VALIDATION NAMEVY, ELECTRIC PERMIT FEE PHONE cONTRUTLETS-SWITCHES-RECEP 10.00/1.00 NA Ad51 LIC.N LIGHTING FIXTURES 10.00/1.00 )DOES5 CraR's PPLIANCES-RESIDENTIAL 4.00 E5 7 _ ' C "HONE / PANELS 10.00 PATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No. SIGNS TRANS. 3.00 ARCH.08 ENG. 500 PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT . . ZIP EMP.METER OR POLE INS. 20.00 APPLICANT S MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE D o o LICENSED CONTRACTORS DECLARATION ¢v I lemby alEnn that 1 am licensed under PlmViSiOIIsof Chapter9 ISSUAN EDATE H 4 w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. P G. MECH. H D 2 Profession Cod u n license is in full for (f •7 ❑ ❑ ❑ z O y- License Cl.s' _ Lic.Nutria, ¢y Date Contractor ERMIT w ¢ OWNER�BUILDHR DECLARATION BUIL OR TION U REFER TO ORD INFORMATION wLL N I hemby affnn that I um exempt from Ere Contractor's License MISC.- VALUATION Hu '0 0< Law for lire following rcuson.ISec.7031.5.Businessand Professions PERMIT ISSUANCE 10.00 Code:Any city c r county which requires a permit to construct,alter, 2 ¢s- Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. - O IS requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO d w m" he is licensed pursuant to the provisions of the Contractor's License n HiQ Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe IV 4 D Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE at H Cr the basis for the alleged exemption.Any violation of5eetion 7031.5 STORIES TYPE CONSTR. dam - by any applicant for permit subjects tire applicant On civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars($5000.): O I,as..all of the property.or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 DCO.GROUP RES.UNITS / their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Basiness and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:'fire Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5A. 0 ) psa ET.FLOOR AREAJ TOTAL ACREAGE ^� ment,am hof intended ownemployees.for sale. If,ed that however. the improve GAS-EA.SYSTEM-I INC.4 OUTLETS 6. 0 p mems arc not into sold or offered for sale.If,however,the building or improvement is rwithin one your of completion,the owner- GAS-EASYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will love firee burden of proving that he did not build or im' . R 0 IND CON PR Omer prove to,Purpose of sine). INDUSTRIAL WASTE INTER. 30.00 (k� El El 1:1 11❑ I,as owner of the property,a n exclusively contracting with p licensed contractors to construct the project(See,7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 \ ASSESSORS PARCEL NO. and Professions Cndc:'Piro Contractor's License Law docs not apply to an owner of property who builds or improves thereon,andwho LAWN SPRINKLERS-OVER 5(EA.) 1.001• contracts for such projects with a coutmctor(s)licensed pursuant to the Contractor's License L.W. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL NO. ❑ I;,n,excmpr under Sec, ,B.&P.C.for this WATER HEATER W/VENT 6.00 A A20 Crux 11 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 Itereby affirm that I have a certificate of conunt to self-insure. ZONING or a certificate of Workers'Compensation Insunce ora certifieJ ENG.SITE NO. ra copy 0,LabC.) Policy u �([Pmr, •(6CL/ Q ❑ Cer11 If yis hereby furnished. FIRESPRINK ENERGY T 24 Z_ Z ❑ CCrY d ' Ry f cit w'Ih tlrc tY I coli division. MISC.- REFER TO ORD. / y❑ N❑ Y ❑ N❑ O Applica I- n PERMIT ISSUANCE i&60 4100 FLOOD ZONE A.L.U.C. CC :RTIFICA'I'li OF li%E?IPTION P WORKF RS' LU _ COMPENSATION INSURANCE PLG,CONTR. LIC.NO. d ❑ (This section need not be completed if the permit is for one TOPLG.TAL A�ee Y❑ NO Y❑ NO ::) Z hundred dollars IS 100)or less) U O 1'certify that in the performance of file work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY UL H mit is issued,1 shall riot employ any Personin any manner so as to O w become subject to the Workers'Compensation Laws of California. BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 } m NOTICE '1'0 APPLICANT': If,after making this Certificate of Iix- F 2 traffics,you should became subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK ,,visions oI'Alm Labor Code, you must forthwith comply with FEE V such provisions or this permit 0.11 be deemed revoked. AIR HANDLING UNIT(TO 10000C.F.M.) 4.00 CONS]'RUCI'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the Performance of tire work for which this permit is issued(Sec. MICROFILM 3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address- HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC . 1 certify that I have read fhis application and state that the above VENTILATION FAN (SINGLE) 4.00 • information n correct. I agree m comply with all oily and county PLUMBING (� ordinances and slate lows refining to building construction, andmy BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby autho De representatives of this city to enter upon the BOILER-COMP love,100,000 BTU)SEE FEE SCH. MECHANICAL ahove-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX PERMIT ISSUANCE 10.00 may in any way accragainst said City in consequence of the ue ling ofthis pennE. MECH.CONT. LIC.NO. MECH. 4� TOTAL TOTAL ) 7 m p aunt/Con I / OFFICE COPY MAURO Stationers, Inc.